To be sure, the Affordable Care Act is Public Enemy No. 1 to the right. But lackluster support from disappointed liberals has also contributed to the law's low public-approval ratings.
While the law still sits below 50 percent approval in the Kaiser Family Foundation's monthly tracking poll, the same survey has found more support for keeping or expanding the law than for repealing it. Republicans' negative enthusiasm far outstrips the intensity of Democrats' support.
"To judge from the partisan vitriol directed against it, one would think the ACA had enacted a fully public, far-left-wing reform from the 1960s rather than the center-right, consumer-choice law now on the books," the Urban Institute paper says.
The paper lays out the basic framework of the health law: creating new marketplaces, known as exchanges, where consumers can more easily buy private insurance. The law envisions each sate establishing its own exchange, and no government-run plan will be available.
Although exchanges are the biggest new program established under the health law, about half of its coverage expansion comes from Medicaid, a public program. (That number will likely shrink as states opt out of the law's Medicaid expansion.)
In the private market, though, the Urban Institute argues that the new law falls well short of the "government takeover" seen by its critics. Most consumers who buy coverage through an exchange will get a subsidy from the federal government, which Republicans see as a new entitlement program. The subsidies are the most expensive part of the law.
But Bovbjerg and Dorn argue that the subsidies are administered in a conservative fashion to bring more people into the market for insurance.
Rather than covering whatever plan a family or its doctor believes is necessary, the federal subsidies are tied to the second-cheapest set of policies available. People who want a more generous plan will have to make up the difference themselves.
Rep. Paul RyanPaul RyanFive fights for Trump’s first year Sunday shows preview: Trump stares down 100-day mark Ryan: Focus is on keeping government open, not healthcare MORE (R-Wis.), the GOP contender for vice president, uses the same benchmark in his plan to offer subsidized private coverage in place of Medicare.
"Government contributes toward a modest plan only, not the best plan or what families or their caregivers consider 'needed,' " the paper states. "This approach is a deeply conservative one, classically espoused by President Reagan’s Commission on Ethics in Medicine."
As Mitt Romney assails "ObamaCare" on the campaign trail, Democrats and pundits often note the similarities between Obama's healthcare law and the reforms that Romney signed as Massachusetts governor. The two are nearly identical in their basic structure, and both include the individual insurance mandate that conservatives have decried.
The Urban Institute concedes that the Affordable Care Act does not rely on the free market for one key objective: reducing the growth in Medicare spending. Romney and Ryan aggressively attack the law's Independent Payment Advisory Board, a panel of 15 experts tasked with cutting Medicare payments to doctors and other hospitals.
Romney and Ryan say the IPAB will end up limiting seniors' access to care. If reimbursements get low enough, doctors will stop taking Medicare and seniors won't be able to get certain services, they say.
The IPAB is prohibited from directly rationing care and is not allowed to change seniors' benefits or cost-sharing.
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